Dissemination and Implementation of a Videoconference Antimicrobial Stewardship Team (VAST)
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 入组人数
- 8
- 试验地点
- 4
- 主要终点
- Days of Antibiotic Therapy / 1000 Bed Days of Care
研究概览
简要总结
Antimicrobial-resistant and healthcare-associated pathogens are a global health threat. The goals of antimicrobial stewardship are to minimize unnecessary and inappropriate antimicrobial use as a means to combat antimicrobial resistance. Previously, the investigators implemented a Videoconference Antimicrobial Stewardship Team (VAST) at 2 VA Medical Centers (VAMCs), using telehealth to connect clinicians at a rural VAMC to a geographically distant infectious disease expert Both VASTs successfully decreased overall antibiotic use in acute and long-term care units. This project will expand the VAST approach to other VAMCs and test the hypothesis that quarterly reports that quantify facility-level antibiotic use will enhance the efficacy of VASTs to support antimicrobial stewardship. This work will directly increase access to antimicrobial stewardship consultation at rural VA facilities, which are often underserved by infectious disease expertise.
详细描述
Background: Antimicrobial stewardship guidelines call for a multidisciplinary team with an infectious disease (ID) physician and ID-trained clinical pharmacist as core members. Unfortunately, there are insufficient ID-trained specialists to staff on-site antimicrobial stewardship programs throughout VA.
Significance: This proposal is highly significant for Veterans and the goals of VA. Veterans experience many of the risk factors associated with development of antimicrobial resistant and healthcare-associated infections. The unprecedented effects of the novel Coronavirus disease 2019 (COVID-19) on the health of Veterans and on the entire healthcare system makes the demand for ID expertise even more apparent, especially in long-term care. Also, this study directly addresses the VA MISSION ACT to improve access to care, timeliness and quality of care, using telehealth services. Finally, this project is aligned with the priorities of operation partners: VA Antimicrobial Stewardship Taskforce (ASTF), the VA National Infectious Disease Service (NIDS), VA Pharmacy Benefits Management (PBM) Services, and the Office of Rural Health.
Innovation and Impact: The design is innovative because the investigators will systematically test and assess implementation barriers to telehealth for antimicrobial stewardship, a novel approach that has not been implemented in VA facilities, other than in the investigators' previous pilot study. Further, the Antibiotic Use Reports (AURs) are an innovative adaptation of peer-comparison, an antibiotic stewardship strategy successful in outpatient settings. This project will provide findings for a scalable model that could be deployed nationally to all applicable VAMCs, continuing the role of VHA as a leader in implementing large-scale interventions focused on prevention and management of ID and stewardship.
Specific Aims: The goal is to implement a multidisciplinary videoconference antimicrobial stewardship team (VAST) in VAMCs using SCAN-ECHO. The central hypothesis is that feedback reports that quantify facility-level antibiotic use will enhance the efficacy of VASTs to support antimicrobial stewardship. The investigators propose a Type 2 hybrid effectiveness-implementation design, comparing clinical effectiveness in sites that implement the VAST alone (VAST-) to sites that implement the VAST augmented by facility-level Antibiotic Use Reports (VAST+). Aims are: 1) Identify and test effective strategies for implementing the VAST; 2) Determine the influence of the VAST overall and VAST+ on the care of Veterans with suspected infections; 3) Determine the influence of the VAST overall and VAST+ on antibiotic use at each VAMC.
Methodology: The investigators will randomize rural VAMCs that do not have ID-trained professionals on staff to implement the VAST alone (VAST-) versus VAST + antibiotic use feedback (VAST+). Aim 1: The investigators will assess modification and adaptations at the intervention sites and by the infectious disease experts. Methods will include process maps and semi-structured interviews to gather qualitative data about what key VAST members perceive as facilitators, barriers and burden to VAST implementation. The investigators will also evaluate costs of implementation. Aim 2: The investigators will evaluate the Veteran population served, clinical activities, and user perceptions of the VAST. The investigators will assess the concordance of clinical care with recommendations from evidence-based clinical practice guidelines. VAST members' perceptions of the quality and timeliness of care will be evaluated. Aim 3: The primary outcome measure will be overall rates of antibiotic use. Secondary outcomes will be changes in the rates of broad-spectrum antibiotic use, antibiotic starts, and length of antibiotic therapy.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Health Services Research
- 盲法
- None
入排标准
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •VA medical centers without local ID expertise that pair with an ID-expert from another VA medical center.
排除标准
- 未提供
研究组 & 干预措施
VAST+
Sites are rural VA Medical Centers that work with an ID physician at different VA to conduct regular discussions about infectious diseases and antimicrobial use for Veterans receiving care at the rural VAMC. These dyads formed the Videoconference Antimicrobial Stewardship Teams or VASTs. VAST+ sites received a brief (2 page) Antibiotic Use Report that described summarized the antibiotic use at the rural VAMC acute care and CLC over the previous month, including a comparison to the average antibiotic use among other rural VAMCs in the same Medical Complexity Group. The Antibiotic Use Reports were distributed quarterly during the intervention period.
干预措施: Antibiotic Use Report (Other)
VAST -
Sites are rural VA Medical Centers that work with an ID physician at different VA to conduct regular discussions about infectious diseases and antimicrobial use for Veterans receiving care at the rural VAMC. These dyads formed the Videoconference Antimicrobial Stewardship Teams or VASTs. VAST- sites received no additional information about antibiotic use at their rural VAMC.
结局指标
主要结局
Days of Antibiotic Therapy / 1000 Bed Days of Care
时间窗: 2.25 years
Days of antibiotic therapy per 1000 days of care (DOT/1000 DOC), measures the overall rate of antibiotic use and is a common metric that accounts for dose adjustments, including for people who receive dialysis. Administration of any dose of an antimicrobial on a given day represents a single DOT for that agent, regardless of the number of times the doses are administered or the dose strength.
Days of Antibiotic Therapy Per 1000 Days of Care
时间窗: The study period was 15 months following each the first meeting held by each VAST. The first 3 months were considered a wash-in period. Data analysis focused on the subsequent 12 month period.
Days of antibiotic therapy per 1000 days of care (DOT/1000 DOC) measures the overall rate of antibiotic use and is a common metric that accounts for dose adjustments, such as for people who receive dialysis. Administration of any dose of an antimicrobial on a given day represents a single DOT for that agent, regardless of the number of times the doses are administered or the dose strength. This metric gauges overall antibiotic use, capturing both the number of prescriptions as well as the length of prescriptions issued. It also helps benchmark use across facilities, tracks prescribing trends, and assesses the impact of stewardship efforts.
次要结局
- Rate of broad-spectrum antibiotics(2.25 years)
- Antibiotic Starts(2.25 years)
- Days of Broad-spectrum Antibiotic Therapy Per 1000 Bed Days of Care(The study period was 15 months following each the first meeting held by each VAST. The first 3 months were considered a wash-in period. Data analysis focused on the subsequent 12 month period.)
- Antibiotic Starts (New Prescriptions)/1000 Bed Days of Care(The study period was 15 months following each the first meeting held by each VAST. The first 3 months were considered a wash-in period. Data analysis focused on the subsequent 12 month period.)